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Based on staff interview, review of the facility's policies and procedures, observations and medical record reviews, the facility failed to ensure nursing staff followed infection control policies and procedures to control infections and communicable diseases of patients (A-0749). The cumulative effect of these practices resulted in the inability to ensure the facility avoided sources and transmission of infections and communicable diseases.

Based on observation, policy and procedure review and interviews, the facility failed to ensure nursing staff performed wound care in accordance with the facility's policies and procedures for two of two patients observed with wounds. (Patient #4 and Patient #8) The facility's active census at the time of the survey was 82.

Findings Include:

The facility's Hand Hygiene policy was reviewed. The policy stated the purpose of hand hygiene is to remove dirt, organic materials, and transient microorganisms or to reduce resident flora. Hand hygiene is only part of a comprehensive approach to providing the patient with a sanitary environment, thus reducing the risk of infection. Hand hygiene is considered the single most important procedure for preventing healthcare associated infections. Bacteria are easily spread in the hospital environment from patient to patient via the hands of healthcare workers. Any contact with the patient or the patient's environment could result in the transfer of microorganisms to the hands. Following Standard Precautions, avoiding contamination of the hands and performing appropriate hand hygiene is essential in helping to prevent the spread of microorganisms. The policy stated hand washing is to be performed for 15 seconds. The policy stated:
B. Indications for hand hygiene:
1. When hands are visibly soiled.
2. Before patient contact.
3. After touching wounds or anybody surface likely to contain body fluids or microorganisms.
4. After contact with inanimate environmental sources likely to be contaminated.
5. After contact with all patients and equipment.
6. After removing gloves.

The facility procedure for Administering Subcutaneous Injections stated to perform hand hygiene, apply clean gloves, administer injection, remove clean gloves and perform hand hygiene.

The facility procedure for Applying a Dressing stated to apply sterile gloves to apply a dry dressing and apply sterile gloves for a moist-to-dry dressing.

1. Patient #4 was admitted to the facility on 12/31/17 with complaints of shortness of breath. The medical record contained an order dated 12/26/17 at 4:52 PM for dressing changes "using sterile technique". Staff F was observed performing wound care for Patient #4 on 01/03/18 at 8:17 AM. Staff F applied clean gloves and removed Patient #4's chest dressing, then disposed of her gloves. Staff F donned a new pair of clean gloves, without performing hand hygiene. On 01/03/18 at 8:23 AM, Staff F performed handwashing for 11.26 seconds, after disposing of dressing supplies, including Patient #4's old dressing.

The findings were shared with Staff A on 01/03/18 at 8:25 AM. On 01/03/18 at 8:43 AM, Staff A confirmed hand washing should have been completed after removing Patient #4's old dressing. On 01/03/18 at 11:07 AM, Staff A verified Staff F should have had on sterile gloves for the chest pacer wire dressing change.

2. Patient #8 was admitted to the facility on 12/28/17 with a chief complaint of left lower leg wound. The medical record contained an order from 01/03/18 at 8:00 AM for a daily, wet to dry dressing to the left lower leg. Staff G was observed performing wound care for Patient #8 on 01/03/17 at 9:00 AM. Patient #8 was in contact isolation for MRSA (Methicillin-resistant Staphylococcus Aureus) to the left leg wound. Staff G washed her hands for 10 seconds before applying clean gloves for the wound care. Staff G opened three 4 x 4 gauze packages and placed them on the outside of the gauze wrapper. Staff G poured saline onto the gauze, rolled the gauze through her gloves and then placed the gauze onto the left leg wound. Staff G covered the gauze with an ABD pad, not gauze as per the facility's procedure. Staff G was observed to clean the wound, dispose of gloves and wash hands for six seconds before donning a new pair of clean gloves. Staff G completed wound care and then went to the computer to document, without performing hand hygiene and still gloved. Staff G flushed Patient #8's left arm intravenous access site with the same gloves that were used to dispose of the wound care supplies. Staff G assessed Patient #4 and was observed administering a subcutaneous injection of Lovenox to Patient #8 with the same gloves that were used on the computer, patient assessment and left arm intravenous access site.

The findings were shared with Staff A on 01/03/18 at 9:50 AM. Staff A reported gloves should have been sterile according to the facility's procedure book. Staff A stated Staff G should have poured the saline onto the gauze while the gauze remained on the inside of the package.